HOSPITAL BOARD INQUIRY.

Taranaki Daily News, Volume LII, Issue 63, 8 April 1909, Page 4

HOSPITAL BOARD INQUIRY.

THE CASE OF THE LATE iii.a BROSXAX. HOSPITAL DOCTOR OX TMAi,. A meeting of the liawera and District Hospital and Charitable Aid Jtouru place on .Monday, the business being in enquire into the circumstances of the case of tile late -Mrs. Dros.ian, 01 Opunake, in connection with whose death certain allegations were made. Til EUP IX AKE COMPL AIX T. The Chairman said he had called the Board together in rele.-ence lo tnc case that occurred at the hospital, and also a letter he had received from a iu.,h at

Opunake, whence the patient came. The letter, signed by Mr M. J. Br. iniau, was then placed before the meeting, and was as follows :

Opunake, March 30. "Dear Sutton, —Tnerc is great indignation in Opunake iu connection mill iluwcra Hospital. The circumstances related, are as follows :

A Mrs Brosnan, who lives on tile Arawliata road, was taken seriously in, .i.il our local doctor was culled in. He considered the case urgent and requiring hospital treatment. The ambulance was got out and sent up to her place about 4 pan. yesterday, it then left Opnniue at 7.30 p.ni. for Hawcra, and von know the tearful night it was. The "ambulance arrived it the hospital and the woman was taken out and put to bed. The matron is reported to have rung the doctor up, and he ordered the patient—l understand without seeing her—to be removed to a private home. She was taken out .uto the ambulance again and taken to a private Home. About a quarter of an hoir after being received in this home she gave birth to a dead child. i M utikt of .the home stated that she did not want such cases. The doctor who was called in wanted the room steamed, and the home owner stated that she had no appliances for steaming. The icsiiit was that the unfortunate patient had to be remov sti. to another home, after having given birth to a child a few hours before. These a-e the circumstances as detailed aere, and if a tenth par; of a is true it is one of the most disgraceful incidents 1 have ever heard of.aiul would lend color' to the miiruiuriiigs so prevalent of late re the unpopularity of vour institution. It is certainly a 'case that wants the strictest enquiry." As the Chairman proceeded to read the letter Drs. Mac Gibbon, Xoonan and Campbell entered the room, and Dr. Mac Gibbon said that as he was on ms trial he would demand an open hearing and thought that everything said bv the Board on this matter should be said before him.

The Chairman assured Dr. Mac Gibbon that the enquiry would be conducted in his presence, but they had Itrat to settle the qnestion of procedure. Mr Sutton said that after full consideration lie had decided to cab the members of the Board together at once to consider this, matter, instead of waiting for the ordinary meeting. It was quite true, as the doctor said, that he was on his trial, and they should nave him present during the enquiry, but he would first like to know what procerinrc to take. The speaker remarked that the patient was first taken to Dr. Noonan at Manaia, who decided to let her come on to Hawera as the other doctor had ordered, although knowing perfectly we.l that the hospital did not admit and had no facilities for dealing with maternity cases.

REGULATION REGARDING MATERNITY CASES.

At the request of Mr Goodland, who asked for the regulation as to maternity patients not being admitted to the hospital, section 102 of the Board's by-laws was read, which was as follows :

" No insane person or persons suffering from delirium tremens, or woman advanced beyond the six months ol pregnancy, or person who after examination .shall be deemed incurable,shall be admitted for hospital treatment, excepting on the special recommendation of the medical superintendent." The Chairman thought it was quite right for the Board to know what state the woman was in when she arrived at Manaia.

Mr Macßeynolds, said the woman was ordered to the Hospital by Dr. Barron, and Dr. Noonan would not interfere with the ease. Mr. Quin: Medical etiquette! Mr. Macßeynolds said that if Dr. Xoo nan gave evidence in the case so should Dr. Barron, but he held that neither should do so.

The Chairman : We want to enquire into the action of the hospital authorities.

Mr Goodland thought the deceased woman's friends should have lieen notified so that thev could have been represented. . Mr Macßeynolds said they had been informed by him of this inquiry ; more than that, he would have brought the registered nurse (who accompanied tiic deceased to Hawera) along to give evidence, but she was busy with another case. If the witness' evidence referred to wa"s not produced before the Hoard lie thought the feeling in the Opunakc district would be that there was something that the Board did not na.: to get at.

The Chairman desired to get the opinion of members as to the position the Board stood in. They might have to call some evidence from Opunakc, but would see as they went along, anil if they found it necessary to do so could adjourn the case.

Members agreed with the view expressed by the Chairman, ami the enquiry opened by .Sister Simpson, of the Jlawera Hospital, being called on to giv evidence. A STRAIGHT OUT ISSUE JjJSMANDED.

Dr. MaeGfbbon, at this juncture, said that it was clearly understood that mo hospital staff and himself w«re On wuir trial, and if adverse to him his resignation would follow as a natural sequeix e. He wanted a fair answer; he did not want to interfere, but he a straight-out answer as to whether th •}• thought he was in the right or wring. The Chairman said so far as the Hoard were concerned they did not wish to put the doctor on his trial, but there nad been a howl from the other end M>piinake|, and it was necessary to hold an enquiry for the benefit of the hospital, the doctor and the Board. Mr Macßeyuolds said everyone connected with the institution was 011 trial. The Chairman pointed out that the patient was taken to Dr. Nbonai'. .it Manaia, but this was not on tile advice of the Opunake doctor.

Dr. Mac Gibbon said lie had askci lit the presence of Dr. Barron.

The Chairman remarked that ti'i'y could not get Dr. Barron .when they rang up, but it was rather late.

Mr Macßcynohes said he had called on Dr. Barron on Saturday, who had given the speaker to umierslund that unless he received special notice nsi;ing him to attend it would not be bis place to do so. WHAT THK XIGHT NTRSK 1)111. The evidence of Sister Simpson \v:is then taken. The witness, night nurse on duty on March 2fltli, .said Mrs. l!i"s nan was unconscious when she arrived at the hospital. Owing to the eonuilioii

the patient was in witness could not take her pulse. Witness put tile patient to bed. She then went to tile telephone to toll tile doctor about the ease, and was tolil to admit the patient, put hot water bottles in tile bed, and wrap her in blanket.-,. Witness did so and tiion ealled the matron. Mr Stunners : Did von not attend the; patient before von rang up the doctor? Witness : No. I did not. There was a brief pause, and the witness was then informed by Dr. MacGibbou that she could leave the room. Mr Muclieynulds objected to witnesses being removed before they had been asked questions by Board members. Dr. Mac Gibbon considered that he had a right to be the last to ask a witness any questions if he thought necessary. Mr Maclteynolds retorted that the doctor was the first gentleman on (rial he had heard of to take charge of the Court.

Dr. Mac Gibbon pointed out that the hospital stall' was under his authority ; but he was actuated by other motives in telling witness she could leave tue room. Ife explained that she was the kind of girl that would faint if kept in the room. Mr Maclieynolds : All the same the serious uncultivated member for Opunake would have asked the Chairman's permission in similar circumstances. THE MATROX'S STATEMENT. The Matron (Miss Clapcottl stated that she was called soon after the ambulance arrived. She read the letter brought with the patient from Dr. Barron, who said that the woman was suffering from eclampsia, and that she hail had lits. Witness said. " Don't admit t'ie case until we let the.doctor know." She was doing this when the woman s uusband and .Johnson, the porter, carried the patient inside. Tile patient was inside the door before she was "admit ted " to the hospital. Before the patient was " admitted " the letter was read to Dr. Mac Gibbon on the telephone, and as it was a stormy night the doctor did not hear the word eclampsia. All the doctor heard was that the woman was suffering from tils and he said " Admil her." Alter the patient was admitted witness asked for particulars of the case, and was informed that the woman was three weeks oil' eoiilinenieut. Hie Husband said the patient had been very ill since 8 o'clock that morning. They had come from beyond Opunake. The husband also said that he had thought of leaving her at Manaia, but Dr. Xoonan had advised them to come on to Hawcra. \\ ituess said there was no mention ol pregnancy in the letter. She then rang up Dr. Mac Gibbon, and it was then the doctor told her the patient had to be removed, it was then that the woman seemed likely to have another lit. 'ine doctor was informed of this, aim nc piescribed treatment, which was carried out. Witness informed the woman's husband that the rules of the institution did not allow maternity cases to be treated. The ambulance was still at the door. When the patient was removed from the hospital she had good " pulse" and was warm.

Mr Goodland asked if any letter from the Opunake doctor came with tile woman.

Witness replied in the affirmative and that it came addressed to Dr. Mac-Gib-bon. That was the liitc intimation they received of the case. Witness was awakened by the noise of the ambulance as it came to the door.

In reply to Mr tioodland, the witness said it was by Dr MaeGiulion.s onters that the patient was removed to a nursing home. Dr. Mac Gibbon had said that if "witness waited a little time he would ring up a nursing home and ask if they would take the patient in, which he did. She was shortly afterwards instructed to send the patient straight away, aid that the doctor would be (here by the time the patient arrived.

Mr MacKevnolds said it was suusiactory to know that the witness' statement continued the husband's statement. DK. BARRON'S LE-TXJiH. The following letter, dated March 2'.1. was from Dr. Barron to the llo.spii.il Superintendent at llawera : Dear Dr. MacGibbon,—This patient I saw this morning at 11 o'clock. I think she is suffering from eclampsia. She had about eight fits while 1 was present, i have had her under chloroform for 2% hours. There is no convenience, and she is situated about eight miles from me with no nurse. 1 am sending her into Hawera Hospital to-night. The husband is naturally anxious about her. and I know you will pull her through. Please bt me know your opinion of the case and how she progresses—Yours faithfully, R. S.- Barron.

'in answer to a query Dr. Mac Gibbon said that a patient suffering from eclampsia was one of the evidences of pregnancy. Htf asked the Board to note particularly the contents of the letter.

Mr Quill's opinion was that the Opunakc doctor committed a grave error in sending the woman away at all. Mr Macßeynolds said the general impression in his district was that Dr. Barron had intended to bring the ease in himself, but had been unable to do Dr. Mac Gibbon referred to Dr. Barron having been within live minutes of the Oaonui telephone, but had scut no message about the case coming in. The matron, in reply to Mr. Marx, said they had no intimation whatever about tliis case prior to the ambulance coining in. In reply to questions, Mr Macßeynolds was informed that the hospital stall'were usually notified when serious cases were coming to the hospital, lie then said he thought it only courtesy on the part of a doctor to send word. Answering Dr. Mac Gibbon, the matron said the patient was never undressed, and was given morphia, about one-eighth of a grain. Mr Quill asked the matron whether the staff would have been able to look after the patient if Dr Mao>ihbon ban decided that she should remain in the hospital. MATERNITY RISKS IN PUBLIC JiOSP'.TALS. Dr Mac Gibbon, answering the query, said in the first place the nurses «crc not maternity nurses. But with two doctors in attendance they could do without that. Then the rules of the institution did not allow of maternity cases being taken in. Had the woman been in a dying condition she would not have been moved from the hospnai. He had consulted one of the best authorities in the North Island on this question (Dr. Christie), and also quoted other authorities to show that in such cases there was hope of saving the patient's life to the verv end. Proceeding, the doctor pointed out that they eouhl not treat such a case in the women's ward, giving scientific reasons, and the only other place thev could have put her was m the operating theatre. On the Monday there was an operation on a man's abdomen and three or four pints ol puss taken awav. The effect* of this were such that he would not dare to do another operation there for three or four days. And a woman in confinement was very readily affected by germs, a statement which' the doctor corroborated by quoting medical authorities. He showed that a maternity patient would incur great risk in a public hospital. Replying to Mr Goodhind. the matron said the woman was in the hospital about three quarters of an hour. If she had been confined while there she would have had t" -lav ; th;"v would not have

turned lii'r out. I)r MacCibhon : If that Hail been so llif patient would have had to Ink.: a risk ilmt she had 7io rig'ht to take. 1)1!. NODXAXS KVIDKNt K was iiiat the partv called on him ami slid they were on their way to the hospital ami simple asked liim to look at the woman. This was about 11.30 ii.ni. Hi- saw tliut *hu was in a serious c lition. s„ In. told them they bad better get on to tin- hospital as quk-kly as possible. In rcpU mi Mr Woodland. Dr. Xonimn said tile patient was not in too serious a condition to be inovi'd. There was always a possibility in these cases. Proceeding, tlic witness wiin that, in sporting parlance the odds were] three or four to one against Iter recovery. But a medical man never gave up hope in these cases until the patient was actual I v dead. The 'chairman: Would you have sent that case here if it had been in ManaiaT Dr. Xoonan: Certainly not. Jlr JlacKevnolds : Did von not ice any symptoms to prevent n'er adinittuncc into the Hawera Hospital ? ])r. Xnonan : 1 never examined the woman for that. Dr. Miicliililinn: What did you lliitik tile case was ?

Dr Xoonan : Just an ordinary ease of eclampsia. To .Mr Goodland the witness said that the pulse and temperature were an indication of the general condition of the woman. Medical men could generally tell by intuition when a case was going to be serious, He agreed with Dr. Mac(iibbon that there was a hope of saving this patient's life. Witness did not take much trouble with the examination, as il was hili' at night, and the woman was in the ambulance, where it was not possible to make a thorough examination. DISCUSSION AXI) EXPLANATIONS. Dr Mac Gibbon outlined the case of eclampsia as diagnosed by Dr. Barron, and detailed the nature of tile Opunake doctor's treatment. Mr Marx thought the enquiry very, very incomplete without Dr Barron be-

ing present. 11 would be an easy matter, Dr MacGibbon pointed out, for Dr liurrnn to have conferred with Dr Xoonan or J)r Maclagan. There was a nursing home ill Opunake under a certificated nurse, and it was there the patient should have been sent. As it was he n.ui received no word about the ease, which! bad been sprung upon him very late at night. If he had known it was a maternity case he would certainly have told Mr Brosnan and Dr Barron that he could not take il in the hospital. Every medical man knew such cases were not taken at the hospitals, and anyone in the district should know thev were not admitted at liawera.

Mr Duirs asked if the patient might | not have been put into one 01 Lie sit-1 intromits at the hospital. '. Dr Mac Gibbon said that could not be I done. As he had said before the rules I ilid not permit of maternity eases being treated. Dr Xoonan pointed out that those cases did not have any chance in hospitals owing to so many germs being about. A woman would be far safer in a whare. The lay mind, he said, did not grasp the fact that there was a great risk in maternity cases being lakeu to public hospitals.

.Mr .Maclteynolds said the conclusion come to by the public was, if you wanted proper attention then by all means go into the private uospiuus. Dr Campbell said the rules plainly stated that no woman should be admitted to the hospital after six months' pregnancy, if they did not have such a rule there would always be maternity cases coming to the hospital. The , Board had the rule, and Dr Mac Gibbon naturally enforced it. The speaker also ', referred to the danger auucuiug to [ maternity cases at public hospitals, and , instanced the septic case at the par- [ ticular time when Mrs Bros'iian was re- [ fused. j Dr Mac Gibbon remarked that when | he was first called on the telephone , about the case he did not eaten tho i word "eclampsia," but only something [ about fits. Later, when lie found out that it was a maternity case, he gave instructions for the woman to oc r°- , moved. Proceeding, the doctor showed that lie had arranged for a bed for the patient at Nurse Warden's, was I there awaiting her arrival, whereas the article in the Opunake paper suggested . that she had been turned out and had nowhere to go. lie would nave descrvt ed "sicking'' it' he nail luriieil the woman out in the middle of the night. . He was there about ten minutes belore

tin' patient arrived preparing for her reception, anil he then sem lor Dr Campbell. The doctor then explained the treatment of the patient, the details of which proved that everything possible that couhl be done for the patient's benefit wa« done by the two doctors, who remained with the patient until about a o'clock in the morning. Mr MaclSeynolds was pleased to say that the latter part of the doctor's statement was supported by the woman's friends, who said .that she had been given all the care, time anil attention that she could possibly receive. J)r Mac Gibbon. contimirng, said he gave up practically the whole of his practice next day' to attend to that patient, lie explained the trouble he had g,uc to ill securing special appliances fur treatment, and how it was necessary to move the patient to another mil-sing home where a steam bath could be used. Jn reply to a question, the doctor said if he had thought the woman had no chance she would not 1 have been removed from the hospital, lint she had a big chance, and he took the case to a nursing liome, where such cases were treated. I)r Campbell said that he had treated one case himself in llawera with an ordinarv nurse in attendance. Dr'Xoonaii had treated live eases during the last four years, and stoutly maintained that patients should never be removed from their homes. There was far less danger in taking the woman awav from the hospital than in keeping lier there. Replying to members, l)r Noonan repeated the latter statement. Answering a query, Dr Macflibbon said cases could not be admitted to Hit hospital unless lie gave permission. Mr Ooodlaud said no patient should be ordered awav until the doctor had seen her. With the ininsent of the members. Dr MacOibbon then reviewed the circuni--lam-i- of the case from the beginning In the end. This showed that lie had b 1 so interested in the case that he oll'ered CI to the nurse if they managed to save her. 11l conclusion, he referred to .Mr Maeltcynnlds' remarks as to the deceased woman's friends appreciation of his treatment. After some remarks had been made about Dr Barron, Or Mac Gibbon said they did not sit in judgment upon Dr Barron. Mr (,liiin did not agree with this view. Mr. Marx said the medical men there agreed that the best had not been done fur that woman, anil the inference was that the Opiiiiuke doctor was to blame. Dr Mac Gibbon, in reply to Mr MaeIteuiolils, said he considered the case should never have been sent to llawera. Mr Marx: That supports the statement that the best was not none. Mr Macßeynolds said the Opunakc doctor bad not done his duty ill not communicating with the hospital. Dr Mac Gibbon referred to the Opunakc Times article, which lie said was libellous and scurrilous from beginning to end. Mr Macßeynolds said the doctrine that maternity cases could not be 1 rented at the public hospital was a hard doctrine for tin; public to • understand. Dr X urn : They will have to understand it. The medical men retired, and the Board then considered the position. The Chairman commented on the difficult nature of Hie business they had in hand, and said i/oin T'ne evidence there was no doubt that the treatment of the patient before the case came to llawera was not what it should have been, but the Board had absolutely nothing to do with that. They "nad to consider the possibilities of (he case after (In- patient came to the hospital, lie referred to the tact that the friends of deceased were represented by their member, although the Opunake doctor was „n t represented. Mr (looillainl raised the question as to whether Dr Macliibhnn would be justified in ordering these removals. He I the speaker) was not prepared to say. The Chairman said the removals that took place after the patient left the hospital bad nothing to do with the Board.

Mr Stanncrs meutiuned that three doctors said that the woman's chances of reoovcrv were less in the liospital. .Mr MacV.eynolds: Are we to be told that the hospital is no place tor patients-; The Chairman: Not for that particular class „f patient. Someone suggested that the fever ward could have been used, but Mr Marx said that if a maternity patient had dieil there tile Hoard would have been blamed straight away. The Chairman said liiey could not put materuilv eases in Hie fever ward: people would say at once that they were consenting id placing patients in a serious position. Mr .Marx suggested Hint the Board should wail for the evidence of the other side (Opunakc). }lr MaclteyiiohU referred In Hie suppo-ition that Dr liarnm was coming in with the case, a rumor generally | circulated in Opunako. lint tliey also wauled the nurse's evidence. It was no faiill of his that tile witness mentioned was n»l present.

Mr Quia thought it a pity that Dr Mac Gibbon had not seen lit'to iorget the regulations uu this ocasioit. Mr Maeßeynolds said it would takt a lot to convince the public that the hospital was not the place for such patients. On the motion of Messrs Maeßeynolds and Goodland. it was decided to adjourn the inquire until Tuesdav, April 13, for the evidence of Dr li.irron and Mrs A. Wallace (Ihe nurse) from Opunake.—Hawcra Star.